Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 003247 | CT |
NPI | 1003002338 |
---|---|
Provider Name | Mrs. Therese Kepler |
First Address | Thomaston, CT 06787-1257 |
Second Address | Waterbury, CT 06708-1459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 20/09/2007 |